Laparoscopic surgery in gynecology: Randomized prospective study comparingpneumoperitoneum and abdominal wall suspension

Objective: To compare laparoscopic surgery using insufflation of carbon dio xide gas with laparoscopic surgery using abdominal wall retractor in gyneco logy. Setting: University hospital. Design: Prospective randomized study. M aterial and methods: Fifty-one patients were assigned to the gasless laparo scopy group, and 52 patients were assigned to the laparoscopy group with pn eumoperitoneum. Patients presented with Ovarian cyst, endometriosis, acute salpingitis, hydrosalpinx and extra-uterine pregnancy. Results: No severe c omplications were noted. One conversion to laparotomy was performed in each group. Eight gasless laparoscopic procedures were converted into laparosco py with pneumoperitoneum; difficulties appeared in patients with adhesions following laparotomy and in cases of unsatisfactory exposure of the pelvis. No differences appeared between the two groups in terms of complications, quality of the operative sequelae, and duration of hospitalization. Conclus ion: Gasless surgery is a recent technique and progress in modifying the eq uipment is necessary to reduce conversions. (C) 1999 Elsevier Science irela nd Ltd. All rights reserved.